Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2022 Jul 7;7(4):e1016.
doi: 10.1097/PR9.0000000000001016. eCollection 2022 Jul-Aug.

Central sensitization in opioid use disorder: a novel application of the American College of Rheumatology Fibromyalgia Survey Criteria

O Trent Hall  1 , Julie Teater  1 , Kara M Rood  2 , K Luan Phan  1 , Daniel J Clauw  3   4
Affiliations

Central sensitization in opioid use disorder: a novel application of the American College of Rheumatology Fibromyalgia Survey Criteria

O Trent Hall et al. Pain Rep. .

Abstract

Introduction: Central sensitization (CS) involves dysfunctional central nervous system pain modulation resulting in heightened pain perception. Central sensitization is not commonly assessed among patients with opioid use disorder (OUD), despite the fact that pain has been implicated in the development, maintenance, and relapse of OUD and chronic opioid use may produce opioid-induced hyperalgesia. Central sensitization is a plausibly important mechanism underlying the complex relationship between OUD and chronic pain. However, this premise is largely untested.

Methods: Participants with OUD (n = 141) were recruited from an academic addiction treatment center in Columbus, Ohio. An established surrogate measure of CS, the American College of Rheumatology 2011 Fibromyalgia Survey Criteria, was administered using electronic survey. Participants also responded to questions about pain interference (Brief Pain Inventory), quality of life (RAND-36), and items regarding pain beliefs and expectations of pain and addiction treatment. Descriptive analyses, Spearman rho correlations, and Mann-Whitney U tests were performed.

Results: Hypothesized relationships were confirmed between degree of CS, pain interference, and health-related quality of life. Degree of CS was also positively correlated with greater endorsement of pain as a reason for the onset, maintenance, and escalation of OUD; treatment delay; and OUD relapse. Participants with the American College of Rheumatology 2011 Fibromyalgia Survey Criteria ≥13 had significantly greater endorsement of pain as a reason for delaying OUD treatment, continuing and increasing opioid use, and precipitating OUD relapse.

Conclusions: This study provides early evidence CS may underlie previously observed connections between clinically salient features of chronic pain and OUD, potentially informing future mechanistic research and precision treatment.

Keywords: Central nervous system sensitization; Chronic pain; Fibromyalgia; Opioid-related disorders.

PubMed Disclaimer

Conflict of interest statement

D.J. Clauw has testified in state lawsuits against opioid manufacturers for their role in the opioid overdose crisis. The remaining authors have no conflicts of interest to declare. Funding was provided by the Care Innovation and Community Improvement Plan (CICIP), a program of the Ohio Department of Medicaid. The views expressed in this publication do not necessarily reflect the official policies of the Ohio Department of Medicaid nor does mention of trade names, commercial practices, or organizations imply endorsement by the government of Ohio.Sponsorships or competing interests that may be relevant to content are disclosed at the end of this article.

Figures

Figure 1.
Figure 1.
Frequency of self-reported pain by body region. Anatomic illustration from the ACR-FMS/Michigan body map. ACR-FMS, American College of Rheumatology 2011 Fibromyalgia Survey Criteria.
Figure 2.
Figure 2.
Relationships between total ACR-FMS score and endorsement of A. pain as a major reason for continuing opioid use, B. needing more and more opioids to control pain, C. delaying OUD treatment for fear that pain will be worse when stopping opioids, and D. worry about pain-precipitated OUD relapse. Responses (Y axis) to original questions were on a 5-point Likert scale and scaled as strongly disagree (1), disagree (2), neutral (3), agree (4), or strongly agree (5). ACR-FMS, American College of Rheumatology 2011 Fibromyalgia Survey Criteria; OUD, opioid use disorder.
Figure 3.
Figure 3.
Group differences (mean with 95% confidence interval) in endorsement of A. pain as a major reason for continuing opioid use, B. needing more and more opioids to control pain, C. delaying OUD treatment for fear that pain will be worse when stopping opioids, and D. worry about pain-precipitated OUD relapse by ACR-FMS cut point ≥13 (consistent with fibromyalgia). Responses (Y axis) to original questions were on a 5-point Likert scale and scaled as strongly disagree (1), disagree (2), neutral (3), agree (4), or strongly agree (5). ACR-FMS, American College of Rheumatology 2011 Fibromyalgia Survey Criteria; OUD, opioid use disorder.
See this image and copyright information in PMC

References

    1. American Psychiatric Association. Diagnostic and statistical manual of mental disorders: DSM-5: Washington: American Psychiatric Association, 2013.
    1. Aoyagi K, He J, Nicol AL, Clauw DJ, Kluding PM, Jernigan S, Sharma NK. A subgroup of chronic low back pain patients with CENTRAL SENSITIZATION. Clin J Pain 2019;35:869–79. - PMC - PubMed
    1. Athanasos P, Smith CS, White JM, Somogyi AA, Bochner F, Ling W. Methadone maintenance patients are cross-tolerant to the antinociceptive effects of very high plasma morphine concentrations. PAIN 2006;120:267–75. - PubMed
    1. Back SE, Gros DF, Price M, LaRowe S, Flanagan J, Brady KT, Davis C, Jaconis M, McCauley JL. Laboratory-induced stress and craving among individuals with prescription opioid dependence. Drug Alcohol Depen 2015;155:60–7. - PMC - PubMed
    1. Basu N, Kaplan CM, Ichesco E, Larkin T, Harris RE, Murray A, Waiter G, Clauw DJ. Neurobiologic features of fibromyalgia are also present among rheumatoid arthritis patients. Arthritis Rheumatol 2018;70:1000–7. - PubMed